[Role of magnetic resonance imaging in the study of patients with diabetic foot syndrome].

OBJECTIVE: To give the results of magnetic resonance imaging (MRI) in patients with complicated diabetic foot syndrome (DFS) to rule out or identify osteomyelitis. MATERIAL AND METHODS: Twenty-seven (14 women and 13 men; mean age 60 ± 12.2 years) with type 1 and 2 diabetes mellitus and suspected osteomyelitis that had developed in the presence of DFS were examined. Ankle joint and foot MRI was carried out in T1-weighted MR image, T2-weighed MRI image, and FSat sequences. The soft tissue, tendoligamentous apparatus, and bones were evaluated. The results of MRI were compared with the data of a clinical follow-up study and surgery, followed by morphological examination. The diagnosis of osteomyelitis was validly established in 7 cases; this disease was absent in 20 patients. RESULTS: MRI showed the highest sensitivity for bone marrow edema (100%), soft tissue swelling (85.7%), and their concurrence (85.7%) and the highest specificity for an extensive wound defect or fistula attached to the bone (100%) and bone marrow edema concurrent with tenosynovitis (90%). With a sensitivity of 14.3% and a specificity of 10%, MRI was of less informative value in assessing bone destruction. It was characterized by moderate sensitivity and moderate specificity for soft tissue destruction (57.1 and 42.9%, respectively) and tenosynovitis (55 and 50%, respectively). CONCLUSION: Osteomyelitis MRI demonstrated a polymorphic pattern with different diagnostic efficiency for individual symptoms.

[Ultrasound monitoring of consolidation processes in fractures of long tubular bones in osteosynthesis using bioactive implants].

OBJECTIVE: To show the capabilities of ultrasound monitoring to assess consolidation processes in fractures of long tubular bones in the use of bioactive material-containing implants. MATERIAL AND METHODS: Eighty-two (45.1%) patients whose bone fragments had been fixed with bioactive material-coated plates and 100 (54.9%) patients with bioinert material-coated ones were examined. Consolidation changes were estimated by ultrasound and X-ray studies 2, 4, 6, and 12 months after surgery. Bone metabolic changes were determined by US osteometry 2 months following surgery. Ultrasound data were compared with the biochemical markers: C-terminal telopeptide (CrossLaps) and osteocalcin. RESULTS AND CONCLUSIONS: Ultrasound monitoring of the rates of consolidation and the time course of changes in bone strength versus the biochemical markers established the positive effect of bioactiveplates on the process of consolidation in fractures of tubular bones and made it possible to consider local osteopenic syndrome to be a prognostically favorable sign of timely callus formation.

[Different types of 199Tl chloride scintigraphic visualization of malignant tumors of the locomotor apparatus].

BACKGROUND: 201Tl chloride scintigraphy allows malignant tumors of the locomotor apparatus to be diagnosed. The capacities of scintigraphy with 199Tl chloride, a 201Tl chloride analog, in addition to routine visualization of malignant tumors of the locomotor apparatus, have revealed its untypical variants. OBJECTIVE: to study the specific features of 199Tl chloride scintigraphic visualization of malignant tumor processes in the locomotor apparatus. SUBJECTS AND METHODS: 199Tl chloride scintigraphy was performed in 85 patients having 107 foci of involvement presented with malignant (n = 57) and benign (n = 50) tumor processes. RESULTS: Malignant tumors were scintigraphically visualized in 98.1% of cases. Three types of their visualization were identified and studied; these included positive (82.4%) and rare: negative (7.8%), and mixed (9.8%) types associated with the specific features of the histological structure, metabolism, and blood supply of neoplasms and with the pharmacodynamic features of 199Tl chloride. The negative and mixed types, unlike metastatic neoplasms, were highly specific to primary or recurrent malignant tumors. CONCLUSION: Consideration of the negative and mixed types of scintigraphic visualization in addition to routine positive one permitted the sensitivity of diagnosis of malignant locomotor tumors to be increased from 90.4 to 98.1%, without reducing the specificity of 199Tl chloride scintigraphy.

[Extrahospital pneumonias: the clinico-scintigraphic characterization and oxidative balance of cells].

Ventilation-perfusion pulmonary scintigraphy was carried out in 30 patients with a verified diagnosis of extra-hospital pneumonia (EHP) and 10 healthy subjects; ventilation-perfusion ratio (V/Q), apex-basis ventilation and perfusion gradient, and the condition of alveolar-capillary permeability (ACP) were analyzed. Clinical symptoms during the debut of EHP were more pronounced in patients with an alveolar type of pulmonary infiltrate (PI) vs. patients with interstitial one: they had pulmonary infiltration syndrome, pleural pain, tachypnoe, tachycardia, a fever of higher than 38 degrees C, and leucocytosis more often. During the acute period of EHP, elevated lipid peroxidation in the erythrocyte membrane as well as a decrease in the content of reduced glutathione and the activity of superoxide dismutase and catalase in erythrocytes did not depend on the type of PI. In EHP, independently of PI type, the study revealed an increase in V/Q of higher than 1.0 on the side of lesion and bilateral (including the healthy side) increase in ACP for radioactive aerosol.

[Arthrosonography in the diagnosis of rheumatoid arthritis of the knee joint]. / Artrosonografiia v diagnostike revmatoidnogo artrita kolennogo sustava.

The paper presents the capacities of echography in the estimation of the activity of rheumatoid gonitis. A study of knee joints in 126 patients with rheumatoid arthritis has provided the basic ultrasound criteria that are characteristic for the first, second, and third degrees of its progression, which include the pattern of proliferative changes in the synovium, the qualitative and quantitative assessments of intraarticular exudate and its viscosity. The capacities of X-ray study and MRI in the detection of the progression of rheumatoid arthritis are discussed. An algorithm of knee joint radiation study is proposed for patients with rheumatoid arthritis.

[Morphological evaluation of modern diagnosis of osteomyelitis]. / Morfologicheskaia otsenka sovremennoi diagnostiki osteomielita.

Current osteomyelitis diagnosis is based on detection of intraosseous abscess using radiopharmaceuticals--67Ga-citrate and 111In-citrin. Morphological examination confirms the presence of inflammation in the zone of local accumulation of radionuclide. A correlation was found between the degree of radionuclide absorption and phase of inflammatory process.

[Quantification of volume of tissue damage in stroke using T2- weighed MRI images]. / Kolichestvennaia otsenka ob"ema ishemicheskogo povrezhdeniia golovnogo mozga po dannym analiza T2-vzveshennykh MRT-izobrazhenii.

We have developed a quantitative technique for scoring of the severity of ischemic damage of the brain using quantitative data of the T2-weighted MRI images of brain in stroke. The principle of the method is the assumption that T2 signal increases proportionally to the severity of ischemic damage of cerebral tissue up to the level equal to intraventricular liquor signal in the case of postinfarction cystic degeneration. Depicting the mean T2-signal from the intraventricular liquor region as Iliq, the signal from ischemic brain area as Iinsult, and from the intact brain as Inorm, obviously, the volume quota of damaged tissue in the total volume of the stroke region is represented by the ratio (Iinsult - Inorm)/(Iliq - Inorm). The total volume of damaged tissue (VDT, cub.cm) in the stroke region is then the following sum taken over all slices i, where the stroke damage can be: VDT = sigma i d.Si.[(Iinsult - Inorm)/(Iliq - Inorm)]i, where d is the slice thickness, Si--area of the ischemic region in the slice i. The quota of damaged tissue in the physical volume of the stroke region is henceforth the following ratio: Q = [sigma i d.Si.[(Iinsult - Inorm)/(Iliq - Inorm)]i]/[sigma i d.Si]. The technique was applied in retrospective analysis of routine MRI studies in 15 patients referred because of acute ischemic stroke. The studies were performed using low-field MRI tomograph Magnetom-Open (Siemens Medical) with field strength 0.22 T. In patients studied during the first day after occurrence of ischemic insult with the minimal degree of acute neurologic deficit, who later have demonstrated clinically full recovery, the VDT was below 20 cm3, and Q was below 10%. In cases with VDT > 25 cm3 and Q > 20% the full regress was not observed in any patient. Henceforth, the quantification of cerebral damage in stroke using quantitative indices based on measurement of T2-parameters over ischemic and intact zones of the brain are of independent prognostic clinical value and improve clinical usefulness of the MRI in ischemic brain stroke.

[Diagnosis of osteomyelitis using Ga-67 citrate]. / Diagnostika osteomielita s pomoshch'iu 67Ga-tsitrata.

To increase the specificity of radionuclide diagnosis of purulent bone affections the authors used Ga-67 citrate which is incorporated into the circulating leukocytes. From the results of examination of 32 patients a comparative characteristics of the diagnostic value of osteotropic agents labeled with Tc-99m and Ga-67 citrate are given. The expediency of using Ga-67 citrate for indicating an inflammatory process in the phase of abscess formation is shown.

[Complex radiodiagnosis of osteomyelitis]. / Kompleksnaia luchevaia diagnostika osteomielita.

In 23 patients with chronic osteomyelitis roentgenography of the bones and three-phase scintigraphy including radionuclide angiography, investigation of the soft tissues and bones were performed. In comparison of the data of clinical examination, roentgenography and radionuclide methods of diagnosis, the correspondence of the data of radionuclide angiography to the phase of an inflammatory process was established.